Red Flags & When to Go In Person for Chest Pain - Pediatric Triage

Audience: pediatric

Chest pain in children is often not caused by serious heart problems, but it can sometimes signal a more urgent condition. Telemedicine can help evaluate many cases safely by discussing symptoms and medical history. However, certain warning signs require immediate in-person medical attention to ensure safety. This guide helps parents and caregivers understand when to use telemedicine for pediatric chest pain and when to seek emergency or urgent care. Recognizing red flags such as difficulty breathing, fainting, or severe pain can be lifesaving. Telemedicine visits can provide advice, symptom monitoring, and guidance on next steps, but they are not a substitute for emergency evaluation when serious symptoms are present.

Red flags — go in person / ER

• Chest pain with difficulty breathing or rapid breathing — seek emergency care immediately.
• Fainting or near-fainting episodes with chest pain — go to emergency department right away.
• Severe or persistent chest pain, especially after trauma — seek urgent in-person evaluation.

What telemedicine can do

• Initial assessment of mild or intermittent chest pain without red flags.
• Reviewing medical history and symptoms related to chest pain.
• Providing guidance on symptom monitoring and home care.
• Advising on when to seek in-person care or emergency services.

What telemedicine cannot do

• Evaluating chest pain with severe symptoms or red flags.
• Performing physical examinations or diagnostic tests like ECG or imaging.
• Managing life-threatening conditions or emergencies.
• Providing immediate treatment for acute chest pain emergencies.

Common Causes of Chest Pain in Children

Most chest pain in children is caused by non-serious issues such as muscle strain, anxiety, or respiratory infections. Heart-related causes are rare but important to consider. Understanding the possible causes helps guide whether telemedicine or in-person care is best.

When Telemedicine Can Help

Telemedicine is useful for initial evaluation of mild chest pain without alarming symptoms. A healthcare provider can ask about the pain's nature, duration, and related symptoms. They can also review medical history and suggest home care or further testing if needed.

Red Flags That Require In-Person Care

Certain signs mean your child needs urgent medical evaluation. These include:

If any of these occur, seek emergency care immediately.

Preparing for a Telemedicine Visit

Before the visit, have the following ready:

After the Telemedicine Visit

Follow the provider’s advice carefully. This may include:

When to Seek Emergency Care Immediately

If your child experiences severe chest pain with any of the red flags mentioned, call emergency services or go to the nearest emergency department without delay. Prompt evaluation is essential for serious conditions.

How to prepare for your tele-visit

• Note the exact time chest pain started and its characteristics (sharp, dull, constant, intermittent).
• List any associated symptoms like fever, cough, dizziness, or palpitations.
• Gather your child’s medical history and current medications.
• Ensure a quiet, well-lit space with reliable internet or phone connection.
• Prepare questions or concerns to discuss with the healthcare provider.

After your tele-visit

• Follow the healthcare provider’s instructions carefully.
• Monitor your child’s symptoms and note any changes.
• Schedule any recommended follow-up appointments or tests.
• Seek immediate care if red flags or worsening symptoms develop.
• Keep a record of the telemedicine visit summary and advice given.

FAQs

Is chest pain common in children?

Yes, chest pain is relatively common in children and is often caused by non-serious issues like muscle strain or anxiety. Serious heart problems are rare but important to rule out.

Can telemedicine diagnose the cause of chest pain?

Telemedicine can help assess symptoms and guide next steps but cannot replace physical exams or tests needed for a definitive diagnosis.

When should I take my child to the emergency room for chest pain?

If your child has chest pain along with difficulty breathing, fainting, severe pain, or chest pain after injury, seek emergency care immediately.

What should I do if my child’s chest pain gets worse after a telemedicine visit?

Contact your healthcare provider promptly and consider going to an emergency department if red flags or severe symptoms appear.

Can anxiety cause chest pain in children?

Yes, anxiety and stress can cause chest pain or discomfort in children. Telemedicine providers can help evaluate and suggest ways to manage anxiety-related symptoms.

Sources

1. Chest Pain in Children — MedlinePlus, U.S. National Library of Medicine.
2. Chest Pain in Children: Evaluation and Management — American Academy of Pediatrics.
3. Chest Pain in Children and Adolescents — Mayo Clinic.
4. Chest Pain in Children and Adolescents — National Library of Medicine.

This telemedicine guidance is for educational and triage purposes only and is not a substitute for in-person medical evaluation or emergency care. If your child has severe symptoms or red flags, seek immediate medical attention.